I 

115TH CONGRESS 

2D SESSION H. R. 5812 

To amend the Public Health Service Act to authorize the Director of the 

Centers for Disease Control and Prevention to carry out certain activities 

to prevent controlled substances overdoses, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 15, 2018 

Mr. GRIFFITH (for himself, Mr. PALLONE, and Mr. FITZPATRICK) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce 

A BILL 

To amend the Public Health Service Act to authorize the 

Director of the Centers for Disease Control and Prevention to carry out certain activities to prevent controlled 

substances overdoses, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Creating Opportunities 

5 that Necessitate New and Enhanced Connections That 

6 Improve Opioid Navigation Strategies Act of 2018’’ or the 

7 ‘‘CONNECTIONS Act’’. 


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1 SEC. 2. PREVENTING OVERDOSES OF CONTROLLED SUB2 STANCES. 

3 Part P of title III of the Public Health Service Act 

4 (42 U.S.C. 280g et seq.) is amended by adding at the end 

5 the following new section: 

6 ‘‘SEC. 399V–7. PREVENTING OVERDOSES OF CONTROLLED 

7 SUBSTANCES. 

8 ‘‘(a) EVIDENCE-BASED PREVENTION GRANTS.— 

9 ‘‘(1) IN GENERAL.—The Director of the Cen10 ters for Disease Control and Prevention may— 

11 ‘‘(A) to the extent practicable, carry out 

12 any evidence-based prevention activity described 

13 in paragraph (2); 

14 ‘‘(B) provide training and technical assist15 ance to States, localities, and Indian tribes for 

16 purposes of carrying out any such activity; and 

17 ‘‘(C) award grants to States, localities, and 

18 Indian tribes for purposes of carrying out any 

19 such activity. 

20 ‘‘(2) EVIDENCE-BASED PREVENTION ACTIVI21 TIES.—An evidence-based prevention activity de22 scribed in this paragraph is any of the following ac23 tivities: 

24 ‘‘(A) With respect to a State, improving 

25 the efficiency and use of the State prescription 

26 drug monitoring program by— 


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1 ‘‘(i) encouraging all authorized users 

2 (as specified by the State) to register with 

3 and use the program and making the pro4 gram easier to use; 

5 ‘‘(ii) enabling such users to access any 

6 updates to information collected by the 

7 program in as close to real-time as pos8 sible; 

9 ‘‘(iii) providing for a mechanism for 

10 the program to automatically flag any po11 tential misuse or abuse of controlled sub12 stances and any detection of inappropriate 

13 prescribing practices relating to such sub14 stances; 

15 ‘‘(iv) enhancing interoperability be16 tween the program and any electronic 

17 health records system, including by inte18 grating the use of electronic health records 

19 into the program for purposes of improving 

20 clinical decisionmaking; 

21 ‘‘(v) continually updating program ca22 pabilities to respond to technological inno23 vation for purposes of appropriately ad24 dressing a controlled substance overdose 


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1 epidemic as such epidemic may occur and 

2 evolve; 

3 ‘‘(vi) facilitating data sharing between 

4 the program and the prescription drug 

5 monitoring programs of neighboring 

6 States; and 

7 ‘‘(vii) meeting the purpose of the pro8 gram established under section 399O, as 

9 described in section 399O(a). 

10 ‘‘(B) Achieving community or health sys11 tem interventions through activities such as— 

12 ‘‘(i) establishing or improving con13 trolled substances prescribing interventions 

14 for insurers and health systems; 

15 ‘‘(ii) enhancing the use of evidence16 based controlled substances prescribing 

17 guidelines across sectors and health care 

18 settings; and 

19 ‘‘(iii) implementing strategies to align 

20 the prescription of controlled substances 

21 with the guidelines described in clause (ii). 

22 ‘‘(C) Evaluating interventions to better un23 derstand what works to prevent overdoses, in24 cluding those involving prescription and illicit 

25 controlled substances. 


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1 ‘‘(D) Implementing projects to advance an 

2 innovative prevention approach with respect to 

3 new and emerging public health crises and op4 portunities to address such crises, such as en5 hancing public education and awareness on the 

6 risks associated with opioids. 

7 ‘‘(b) ENHANCED SURVEILLANCE OF CONTROLLED

8 SUBSTANCE OVERDOSE GRANTS.— 

9 ‘‘(1) IN GENERAL.—The Director of the Cen10 ters for Disease Control and Prevention may— 

11 ‘‘(A) to the extent practicable, carry out 

12 any controlled substance overdose surveillance 

13 activity described in paragraph (2); 

14 ‘‘(B) provide training and technical assist15 ance to States for purposes of carrying out any 

16 such activity; 

17 ‘‘(C) award grants to States for purposes 

18 of carrying out any such activity; and 

19 ‘‘(D) coordinate with the Assistant Sec20 retary for Mental Health and Substance Use to 

21 collect data pursuant to section 505(d)(1)(A) 

22 (relating to the number of individuals admitted 

23 to the emergency rooms of hospitals as a result 

24 of the abuse of alcohol or other drugs). 


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1 ‘‘(2) CONTROLLED SUBSTANCE OVERDOSE SUR2 VEILLANCE ACTIVITIES.—A controlled substance 

3 overdose surveillance activity described in this para4 graph is any of the following activities: 

5 ‘‘(A) Enhancing the timeliness of reporting 

6 data to the public, including data on fatal and 

7 nonfatal overdoses of controlled substances. 

8 ‘‘(B) Enhancing comprehensiveness of data 

9 on controlled substances overdoses by collecting 

10 information on such overdoses from appropriate 

11 sources such as toxicology reports, autopsy re12 ports, death scene investigations, and other risk 

13 factors. 

14 ‘‘(C) Using data to help identify risk fac15 tors associated with controlled substances 

16 overdoses. 

17 ‘‘(D) With respect to a State, supporting 

18 entities involved in providing information to in19 form efforts within the State, such as by coro20 ners and medical examiners, to improve accu21 rate testing and reporting of causes and con22 tributing factors to controlled substances 

23 overdoses. 


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1 ‘‘(E) Working to enable information shar2 ing regarding controlled substances overdoses 

3 among data sources. 

4 ‘‘(c) DEFINITIONS.—In this section: 

5 ‘‘(1) CONTROLLED SUBSTANCE.—The term 

6 ‘controlled substance’ has the meaning given that 

7 term in section 102 of the Controlled Substances 

8 Act. 

9 ‘‘(2) INDIAN TRIBE.—The term ‘Indian tribe’ 

10 has the meaning given that term in section 4 of the 

11 Indian Self-Determination and Education Assistance 

12 Act. 

13 ‘‘(d) AUTHORIZATION OF APPROPRIATIONS.—For 

14 purposes of carrying out this section and section 399O, 

15 there is authorized to be appropriated $486,000,000 for 

16 each of fiscal years 2019 through 2023.’’. 

17 SEC. 3. PRESCRIPTION DRUG MONITORING PROGRAM. 

18 Section 399O of the Public Health Service Act (42 

19 U.S.C. 280g–3) is amended to read as follows: 

20 ‘‘SEC. 399O. PRESCRIPTION DRUG MONITORING PROGRAM. 

21 ‘‘(a) PROGRAM.— 

22 ‘‘(1) IN GENERAL.—Each fiscal year, the Sec23 retary, in consultation with the Director of National 

24 Drug Control Policy, acting through the Director of 

25 the Centers for Disease Control and Prevention, the 


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1 Assistant Secretary for Mental Health and Sub2 stance Use, and the National Coordinator for Health 

3 Information Technology, shall support States for the 

4 purpose of improving the efficiency and use of 

5 PDMPs, including— 

6 ‘‘(A) establishment and implementation of 

7 a PDMP; 

8 ‘‘(B) maintenance of a PDMP; 

9 ‘‘(C) improvements to a PDMP by— 

10 ‘‘(i) enhancing functional components 

11 to work toward— 

12 ‘‘(I) universal use of PDMPs 

13 among providers and their delegates, 

14 to the extent that State laws allow, 

15 within a State; 

16 ‘‘(II) more timely inclusion of 

17 data within a PDMP; 

18 ‘‘(III) active management of the 

19 PDMP, in part by sending proactive 

20 or unsolicited reports to providers to 

21 inform prescribing; and 

22 ‘‘(IV) ensuring the highest level 

23 of ease in use and access of PDMPs 

24 by providers and their delegates, to 

25 the extent that State laws allow; 


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1 ‘‘(ii) improving the intrastate inter2 operability of PDMPs by— 

3 ‘‘(I) making PDMPs more ac4 tionable by integrating PDMPs within 

5 electronic health records and health 

6 information technology infrastructure; 

7 and 

8 ‘‘(II) linking PDMP data to 

9 other data systems within the State, 

10 including— 

11 ‘‘(aa) the data of pharmacy 

12 benefit managers, medical exam13 iners and coroners, and the 

14 State’s Medicaid program; 

15 ‘‘(bb) worker’s compensation 

16 data; and 

17 ‘‘(cc) prescribing data of 

18 providers of the Department of 

19 Veterans Affairs and the Indian 

20 Health Service within the State; 

21 ‘‘(iii) improving the interstate inter22 operability of PDMPs through— 

23 ‘‘(I) sharing of dispensing data in 

24 near-real time across State lines; and 


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1 ‘‘(II) integration of automated 

2 queries for multistate PDMP data 

3 and analytics into clinical workflow to 

4 improve the use of such data and ana5 lytics by practitioners and dispensers; 

6 or 

7 ‘‘(iv) improving the ability to include 

8 treatment availability resources and refer9 ral capabilities within the PDMP. 

10 ‘‘(2) STATE LEGISLATION.—As a condition on 

11 the receipt of support under this section, the Sec12 retary shall require a State to demonstrate that the 

13 State has enacted legislation or regulations— 

14 ‘‘(A) to provide for the implementation of 

15 the PDMP; and 

16 ‘‘(B) to permit the imposition of appro17 priate penalties for the unauthorized use and 

18 disclosure of information maintained by the 

19 PDMP. 

20 ‘‘(b) PDMP STRATEGIES.—The Secretary shall en21 courage a State, in establishing, improving, or maintaining 

22 a PDMP, to implement strategies that improve— 

23 ‘‘(1) the reporting of dispensing in the State of 

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1 porting occurs not later than 24 hours after the dis2 pensing event; 

3 ‘‘(2) the consultation of the PDMP by each pre4 scribing practitioner, or their designee, in the State 

5 before initiating treatment with a controlled sub6 stance, or any substance as required by the State to 

7 be reported to the PDMP, and over the course of 

8 ongoing treatment for each prescribing event; 

9 ‘‘(3) the consultation of the PDMP before dis10 pensing a controlled substance, or any substance as 

11 required by the State to be reported to the PDMP; 

12 ‘‘(4) the proactive notification to a practitioner 

13 when patterns indicative of controlled substance mis14 use by a patient, including opioid misuse, are de15 tected; 

16 ‘‘(5) the availability of data in the PDMP to 

17 other States, as allowable under State law; and 

18 ‘‘(6) the availability of nonidentifiable informa19 tion to the Centers for Disease Control and Preven20 tion for surveillance, epidemiology, statistical re21 search, or educational purposes. 

22 ‘‘(c) DRUG MISUSE AND ABUSE.—In consultation 

23 with practitioners, dispensers, and other relevant and in24 terested stakeholders, a State receiving support under this 

25 section— 


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1 ‘‘(1) shall establish a program to notify practi2 tioners and dispensers of information that will help 

3 to identify and prevent the unlawful diversion or 

4 misuse of controlled substances; and 

5 ‘‘(2) may, to the extent permitted under State 

6 law, notify the appropriate authorities responsible 

7 for carrying out drug diversion investigations if the 

8 State determines that information in the PDMP 

9 maintained by the State indicates an unlawful diver10 sion or abuse of a controlled substance. 

11 ‘‘(d) EVALUATION AND REPORTING.—As a condition 

12 on receipt of support under this section, the State shall 

13 report on interoperability with PDMPs of other States and 

14 Federal agencies, where appropriate, intrastate interoper15 ability with health information technology systems such as 

16 electronic health records, health information exchanges, 

17 and e-prescribing, where appropriate, and whether or not 

18 the State provides automatic, up-to-date, or daily informa19 tion about a patient when a practitioner (or the designee 

20 of a practitioner, where permitted) requests information 

21 about such patient. 

22 ‘‘(e) EVALUATION AND REPORTING.—A State receiv23 ing support under this section shall provide the Secretary 

24 with aggregate nonidentifiable information, as permitted 

25 by State law, to enable the Secretary— 


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1 ‘‘(1) to evaluate the success of the State’s pro2 gram in achieving the purpose described in sub3 section (a); or 

4 ‘‘(2) to prepare and submit to the Congress the 

5 report required by subsection (i)(2). 

6 ‘‘(f) EDUCATION AND ACCESS TO THE MONITORING

7 SYSTEM.—A State receiving support under this section 

8 shall take steps to— 

9 ‘‘(1) facilitate prescribers and dispensers, and 

10 their delegates, as permitted by State law, to use the 

11 PDMP, to the extent practicable; and 

12 ‘‘(2) educate prescribers and dispensers, and 

13 their delegates on the benefits of the use of PDMPs. 

14 ‘‘(g) ELECTRONIC FORMAT.—The Secretary may 

15 issue guidelines specifying a uniform electronic format for 

16 the reporting, sharing, and disclosure of information pur17 suant to PDMPs. 

18 ‘‘(h) RULES OF CONSTRUCTION.— 

19 ‘‘(1) FUNCTIONS OTHERWISE AUTHORIZED BY

20 LAW.—Nothing in this section shall be construed to 

21 restrict the ability of any authority, including any 

22 local, State, or Federal law enforcement, narcotics 

23 control, licensure, disciplinary, or program authority, 

24 to perform functions otherwise authorized by law. 


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1 ‘‘(2) ADDITIONAL PRIVACY PROTECTIONS.— 

2 Nothing in this section shall be construed as pre3 empting any State from imposing any additional pri4 vacy protections. 

5 ‘‘(3) FEDERAL PRIVACY REQUIREMENTS.— 

6 Nothing in this section shall be construed to super7 sede any Federal privacy or confidentiality require8 ment, including the regulations promulgated under 

9 section 264(c) of the Health Insurance Portability 

10 and Accountability Act of 1996 (Public Law 104– 

11 191; 110 Stat. 2033) and section 543 of this Act. 

12 ‘‘(4) NO FEDERAL PRIVATE CAUSE OF AC13 TION.—Nothing in this section shall be construed to 

14 create a Federal private cause of action. 

15 ‘‘(i) PROGRESS REPORT.—Not later than 3 years 

16 after the date of enactment of the CONNECTIONS Act, 

17 the Secretary shall— 

18 ‘‘(1) complete a study that— 

19 ‘‘(A) determines the progress of States in 

20 establishing and implementing PDMPs con21 sistent with this section; 

22 ‘‘(B) provides an analysis of the extent to 

23 which the operation of PDMPs has— 


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1 ‘‘(i) reduced inappropriate use, abuse, 

2 diversion of, and overdose with, controlled 

3 substances; 

4 ‘‘(ii) established or strengthened ini5 tiatives to ensure linkages to substance use 

6 disorder treatment services; or 

7 ‘‘(iii) affected patient access to appro8 priate care in States operating PDMPs; 

9 ‘‘(C) determine the progress of States in 

10 achieving interstate interoperability and intra11 state interoperability of PDMPs, including an 

12 assessment of technical, legal, and financial 

13 barriers to such progress and recommendations 

14 for addressing these barriers; 

15 ‘‘(D) determines the progress of States in 

16 implementing near real-time electronic PDMPs; 

17 ‘‘(E) provides an analysis of the privacy 

18 protections in place for the information re19 ported to the PDMP in each State receiving 

20 support under this section and any rec21 ommendations of the Secretary for additional 

22 Federal or State requirements for protection of 

23 this information; 

24 ‘‘(F) determines the progress of States in 

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1 tralized data storage, such as peer-to-peer file 

2 sharing or data pointer systems, in PDMPs and 

3 the potential for such alternatives to enhance 

4 the privacy and security of individually identifi5 able data; and 

6 ‘‘(G) evaluates the penalties that States 

7 have enacted for the unauthorized use and dis8 closure of information maintained in PDMPs, 

9 and the criteria used by the Secretary to deter10 mine whether such penalties qualify as appro11 priate for purposes of subsection (a)(2); and 

12 ‘‘(2) submit a report to the Congress on the re13 sults of the study. 

14 ‘‘(j) ADVISORY COUNCIL.— 

15 ‘‘(1) ESTABLISHMENT.—A State may establish 

16 an advisory council to assist in the establishment, 

17 improvement, or maintenance of a PDMP consistent 

18 with this section. 

19 ‘‘(2) LIMITATION.—A State may not use Fed20 eral funds for the operations of an advisory council 

21 to assist in the establishment, improvement, or 

22 maintenance of a PDMP. 

23 ‘‘(3) SENSE OF CONGRESS.—It is the sense of 

24 the Congress that, in establishing an advisory coun25 cil to assist in the establishment, improvement, or 


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1 maintenance of a PDMP, a State should consult 

2 with appropriate professional boards and other inter3 ested parties. 

4 ‘‘(k) DEFINITIONS.—For purposes of this section: 

5 ‘‘(1) The term ‘controlled substance’ means a 

6 controlled substance (as defined in section 102 of 

7 the Controlled Substances Act) in schedule II, III, 

8 or IV of section 202 of such Act. 

9 ‘‘(2) The term ‘dispense’ means to deliver a 

10 controlled substance to an ultimate user by, or pur11 suant to the lawful order of, a practitioner, irrespec12 tive of whether the dispenser uses the internet or 

13 other means to effect such delivery. 

14 ‘‘(3) The term ‘dispenser’ means a physician, 

15 pharmacist, or other person that dispenses a con16 trolled substance to an ultimate user. 

17 ‘‘(4) The term ‘interstate interoperability’ with 

18 respect to a PDMP means the ability of the PDMP 

19 to electronically share reported information with an20 other State if the information concerns either the 

21 dispensing of a controlled substance to an ultimate 

22 user who resides in such other State, or the dis23 pensing of a controlled substance prescribed by a 

24 practitioner whose principal place of business is lo25 cated in such other State. 


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1 ‘‘(5) The term ‘intrastate interoperability’ with 

2 respect to a PDMP means the integration of PDMP 

3 data within electronic health records and health in4 formation technology infrastructure or linking of a 

5 PDMP to other data systems within the State, in6 cluding the State’s Medicaid program, workers’ com7 pensation programs, and medical examiners or coro8 ners. 

9 ‘‘(6) The term ‘nonidentifiable information’ 

10 means information that does not identify a practi11 tioner, dispenser, or an ultimate user and with re12 spect to which there is no reasonable basis to believe 

13 that the information can be used to identify a practi14 tioner, dispenser, or an ultimate user. 

15 ‘‘(7) The term ‘PDMP’ means a prescription 

16 drug monitoring program that is State-controlled. 

17 ‘‘(8) The term ‘practitioner’ means a physician, 

18 dentist, veterinarian, scientific investigator, phar19 macy, hospital, or other person licensed, registered, 

20 or otherwise permitted, by the United States or the 

21 jurisdiction in which the individual practices or does 

22 research, to distribute, dispense, conduct research 

23 with respect to, administer, or use in teaching or 

24 chemical analysis, a controlled substance in the 

25 course of professional practice or research. 


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1 ‘‘(9) The term ‘State’ means each of the 50 

2 States, the District of Columbia, and any common3 wealth or territory of the United States. 

4 ‘‘(10) The term ‘ultimate user’ means a person 

5 who has obtained from a dispenser, and who pos6 sesses, a controlled substance for the person’s own 

7 use, for the use of a member of the person’s house8 hold, or for the use of an animal owned by the per9 son or by a member of the person’s household. 

10 ‘‘(11) The term ‘clinical workflow’ means the 

11 integration of automated queries for prescription 

12 drug monitoring programs data and analytics into 

13 health information technologies such as electronic 

14 health record systems, health information exchanges, 

15 and/or pharmacy dispensing software systems, thus 

16 streamlining provider access through automated que17 ries.’’. 

Æ 


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